PRISON BASED DRUG TREATMENT FOR WOMEN: OFFENDERS PERSPECTIVES ON DRUG RECOVERY WINGS. Sharon Grace University of York

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1 PRISON BASED DRUG TREATMENT FOR WOMEN: OFFENDERS PERSPECTIVES ON DRUG RECOVERY WINGS. Sharon Grace University of York

2 BACKGROUND WOMEN PRISONERS The majority of women in prison: Have highly complex needs; suffer both from multiple disadvantage; and disproportionately from substance misuse, mental health issues, and experiences of physical, mental and/or sexual abuse (see inter alia Malloch and McIvor, 2011; Hamilton and Fitzpatrick, 2006; Gelsthorpe and Morris, 2002; Moloney and Mollor, 2009; Leverentz, 2006). Prison does not generally help women offenders move on to lives free from abuse, drug and alcohol use and crime; and exacerbates their problems so that they return to the community in a worse position. (Carlen and Tombs, 2006; Barlett, 2007; Clarke, 2004; Barry and McIvor, 2010). Women are often sent to prison despite presenting a low risk to the public and committing non-violent offences often due to poor community options or misguided sentencing. (McIvor and Burman, 2011).

3 DRUG USING WOMEN OFFENDERS Globally, more women are incarcerated for drug offences than for any other crime (Moloney and Moller, 2009). Drug use amongst women offenders is higher/more serious than amongst male offenders: more likely to report Class A drug use and that their offending was directly linked to supporting that drug use (Light et al, 2013). more likely to report needing help with their drug use on entry to prison and to require clinical detoxification (Corston, 2007; PRT, 2013). have more complex reasons for drug use than that of men (NTA, 2010b) Women prisoners are particularly complicated, hard-core, end-stage drug users and may continue to use drugs in prison to cope with stress particularly due to separation from their children (Borrill et al 2003, p18). Many women are however reluctant to seek out help for their drug use for fear that their children will be taken into care but once in treatment, women are more likely than men to engage, stay longer and get better results (NTA, 2010b).

4 THE DEVELOPMENT OF DRUG RECOVERY WINGS DRWs are also situated within the recent broader recovery movement leading to a call for drug services to focus on the person not the substance (Centre for Social Justice 2007, p19), and an end to people being parked indefinitely on methadone (NTA 2010a). In 2010, the UK Government s Drug Strategy established an intention to bring wing-based, abstinence focused, drug recovery services to English and Welsh prisons (HM Govt 2010, p12). Ministry of Justice Green Paper called for a renewed focus on recovery outcomes, challenging offenders to come off drugs, identifying pilot Drug Recovery Wings (DRWs) as a key vehicle for achieving these ends (Ministry of Justice, 2010, p29). Pilot DRWs were to be entered on a voluntary basis by offenders who have the goal to be drug free (PIRU 2012, p2). Five pilots in men s prisons began in early 2011; followed by five additional prisons including two women s prisons in 2012.

5 THE DRW RESEARCH In 2012 the Department of Health commissioned the University of York to lead a team of researchers from York, Glasgow and Cambridge to undertake a process and impact evaluation of the pilot Drug Recovery Wings. The evaluation aims to provide a detailed description of the operation of individual DRWs and to assess the degree to which participation within a DRW facilitates individual prisoners recovery and rehabilitation. Initial findings from a rapid assessment of the two women s DRWs are presented here focusing on the women s views of the programme. Women have been followed up in the community and those findings will be available in due course. 10 of the 11 women on DRW1 were interviewed and 6 of the 9 on DRW2.

6 PROFILE OF THE WOMEN The women ranged in age from 19 to 62 and were serving relatively long sentences only two were serving sentences of less than 12 months. Most of the women had a long history of drug use ranging from 8 to 46 years with an average of 17 years use and most had their main problem with heroin and/or crack cocaine. Several of the women also had a long relationship with methadone. Many women described loss of children into the care system; a deterioration of their mental and physical health; violent, dysfunctional relationships with men; and the loss of a significant loved one (a parent, child or partner). The majority of women had undertaken, or were in the process of undertaking detoxification: One of the prisons insisted on detox on entrance to the DRW (DRW2); DRW1 was more flexible.

7 STRUCTURE OF THE DRW PROGRAMMES On both DRWs there were eight members of staff working on the wing at DRW1 these were all drug workers; whilst at DRW2 they were all discipline staff. Both DRWs were physically separate from the rest of the prison, with the women eating and living together on the DRW. On DRW1 the women s days were divided into two with mornings dedicated to their recovery programme and afternoons involving education and/or employment and key worker sessions. A holistic approach was taken in DRW1 with a variety of aspects of a woman s life worked on to support recovery. This was most clearly manifest in the use of the Outcome Star.

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9 STRUCTURE OF THE DRW PROGRAMMES On DRW2, the women were also totally isolated from the rest of the prison, they did not work, and all their time was spent on the DRW. There was a brief, mainly administrative morning meeting at 9.00am. Three mornings a week the women attended group work sessions which at the time of the research was focused on Mindfulness. Most afternoons were free time other than two gym sessions per week. The women complained of being bored.

10 WOMEN S VIEWS OF THE DRW PROGRAMMES: PEER SUPPORT The majority of the women said peer support was the best aspect, with everyone working towards the same goals and supporting each other. They described how important it was that everyone had the same mindset and that the usual positive drugs talk endemic in prison was not present: Because we re all like-minded people, we re all wanting the same thing and it s good to see that kind of community spirit (Vicky, DRW1)

11 WOMEN S VIEWS OF THE DRW PROGRAMMES: EMOTIONAL AND PHYSICAL SAFETY All the women agreed that they felt far safer on the DRW that in the main prison and that this aided their recovery. This was achieved in DRW2 by isolation from the rest of the prison population: Because you can get your hands on anything. You could easily go into that main jail to go and get your hands on something. There s probably more drugs in there than there is on the streets. (Alice,DRW2) Even in DRW1, where the women went out into the main prison to work in the afternoon, they still felt protected from the temptation to use drugs: and you re out and about and you just see them and it s hi, and like if they go to offer you something you can say no, not interested. But if it s in your face 24/7, say on the wing you were doubled up with somebody, a user, or if you were on the house then it would start to wear you down (Lacey,DRW1)

12 WOMEN S VIEWS OF THE DRW PROGRAMMES: NON-JUDGEMENTAL AND EMPATHETIC STAFF DRW1 was run exclusively by drug workers rather than discipline staff and several women mentioned the quality of these staff as crucial: Brilliant absolutely brilliant all of them. (Jodie, DRW1) Very supportive. Just what I don t think that there s anything more that they could do, if you know what I mean, than what they do. (Nicola, DRW1) The women talked about how effective their key workers, at acknowledging progress and at getting them to identify some of the issues they had found it difficult to address: Well, we set small goals, so instead of it s like all my small goals now lead to my long-term ones, but it s not so scary, because the key workers talk us through our small goal settings. And we can actually write them on paper and see our progress. (Nicola, DRW1)

13 WOMEN S VIEWS OF THE DRW PROGRAMMES: STAFF/PRISONER RELATIONSHIPS In contrast, relationships on DRW2, which was run predominantly by discipline staff, were more strained. The key issue was the staff s lack of understanding of the process of detoxification: When the girls are going through detox and that they [staff] don t understand the shouting and all the girls emotions are coming out. All our emotions are out. They re just going to burst into tears and not know what they re crying for and they re going to end up getting warnings, negative comments shouted back at them (Alice, DRW2).

14 WOMEN S VIEWS OF THE DRW PROGRAMMES: ONE STOP SHOP Contact with outside agencies on DRW1 gave the women options for accessing support in the community both in terms of drug treatment and more generally. Getting help within one setting was really appreciated. So I think the massive thing is that organisations come in to help us for when we get outside. It s the throughcare that s best for me, because even though I m going to rehab, I want all these ideas for when I get out of rehab, when I m starting on my own in my life to rebuild myself (Nicola, DRW1). Having ex-users come in seemed particularly useful in providing role models for the women and offering them real hope that long term change was possible: We ve had quite a few come through and talk and we ve had ex-offenders and exdrug addicts coming through it is [helpful] because you can see how well they ve done and think oh god, I want to be there. (Vicky, DRW1). In contrast the women on DRW2 had to use the general services in the prison to manage any contact with outside agencies.

15 SUMMARY OF FINDINGS DRW1 provided a safe and supportive environment offering a combination of therapeutic and practical support within a supportive community. The approach is holistic rather than solely addressing drug use. Progress as well as outcomes are acknowledged. Both DRWs were safe places with women protected from the temptation of drugs available in the wider prison. But it was clear from DRW2 that isolation in itself is not enough. DRW1 offered an emotionally safe place too, where women felt more able to open up about their issues and concerns. This was far less evident in DRW2 where relationships between the women and staff and the lack of an structured recovery programme limited the effectiveness of the intervention.

16 ISSUES TO CONSIDER The need to develop continuity of care and a clear exit strategy, connecting women immediately to services in the community on release. The need to develop consistency of good practice with DRWs being more widely established and consistently available throughout the women s estate. More radically, the development of geographically dispersed custodial units advocated by Corston (2007) to replace women s prisons. Each custodial unit could be modelled on a DRW1 type intervention which could be connected to a community service with a planned exit strategy straight from the custodial unit to the community service. An attempt to develop facilities in the community as an alternative to prison for low-risk, non-violent women offenders. These could offer accommodation for women on release so that they could avoid inappropriate hostel accommodation and in time be able to take responsibility for their children.

17 ISSUES TO CONSIDER It is clear that for some women, help for their substance misuse ends when they leave prison - particularly those women who are serving under 12 months undermining all their progress made whilst in prison. Consistently linking such custodial units and community services could provide the type of long term support that drug using women offenders need. It is clear that without such support, it is all too easy to slip back into a life of drug use and crime.

18 REFERENCES Barry, M and McIvor, G (2010) Professional decision making and women offenders: Containing the chaos? Probation Journal, Vol 57(1) p27-41 Bartlett, A (2007) Women in prison: concepts, clinical issues and care delivery. Psychiatry, 6(11), p Borrill, J; Maden, A; Martin, A; Weaver, T; Stimson, G; Farrell, M and Barnes T (2003) Differential substance misuse treatment needs of women, ethnic minorities and young offenders in prison: prevalence of substance misuse and treatment needs. Home Office Online Report 33/03. London: Home Office. Brown, M and Ross, S (2010) Mentoring, social capital and desistance: a study of women released from prison Australian and New Zealand Journal of Criminology, Vol 43(1),p Carlen, P and Tombs, J (2006) Reconfigurations of penality: The ongoing case of the women s imprisonment and reintegration industries Theoretical Criminology, Vol 10(3), p Centre for Social Justice (2007) Breakthrough Britain: Addictions. London: Centre for Social Justice Clark, R (2004) What works? for women who offend: A service user s perspective: Exploring the synthesis between what women want and what women get. Research Paper 2004/04. London: The Griffins Society. Corston, Baroness, J (2007) The Corston Report: A report by Baroness Jean Corston of a review of women with particular vulnerabilities in the Criminal Justice System. London: Home Office.

19 REFERENCES (2) Covington, S (2002) A Woman s Journey Home: Challenges for female offenders and their children. From Prison to Home conference proceedings. Available at: last accessed 22 September 2014 Dean, E (2013) A brighter future. Nursing Standard Vol 28 (9) p Douglas, N; Plugge, E and Fitzpatrick, R (2009) The impact of imprisonment on health: what do women prisoners say? Journal of Epidemiology and Community Health Vol 63, Gelsthorpe, L and Morris, A (2002) Women s imprisonment in England and Wales: A penal paradox Criminology and Criminal Justice Vol 2(3) p Hamilton, S and Fitzpatrick, R (2006) Working with Complexity: meeting the resettlement needs of women at HMP Styal. London: Revolving Doors Agency Hardwick, N (2012) Transcript of the speech given at Issues in Criminal Justice Conference 29 February. The University of Sussex. Available at %20Corston%20Speech%20-%20Women_in_prison% (1).pdf [accessed 29 April 2014] HM Government (2010) Drug Strategy 2010: Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life. London: HM Government House of Commons Justice Committee (2013) Women Offenders: after the Corston Report. HC92 London: The Stationary Office. Howitt D and Cramer D (2005) Introduction to Statistics in Psychology (3 rd Edn.). Essex: Pearson

20 REFERENCES (3) Leverentz, A (2006) The love of a good man? Romantic relationships as a source of support or hindrance for female exoffenders Journal of Research in Crime and Delinquency, Vol 43(4), p Light, M; Grant, E and Hopkins, K (2013) Gender Differences in Substance Misuse and Mental Health amongst Prisoners: Results from the Surveying Prisoner Crime Reduction (SPCR) longitudinal cohort study of prisoners. Ministry of Justice Analytical Series. London: Ministry of Justice. Malloch, M and McIvor, G (2011) Women and community sentences Criminology and Criminal Justice, Vol 11(4), p McIvor, G and Burman, M (2011) Understanding the Drivers of Female Imprisonment in Scotland. Scottish Centre for Crime and Justice Research Briefing 02/2011 Ministry of Justice (2010) Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders. London: Ministry of Justice. Moloney, K P and Moller, L F (2009) Good practice for mental health programming for women in prison: Reframing the parameters. Public Health 123, p National Treatment Agency (2010a) Business plan London: NTA National Treatment Agency (2010b) Women in Drug Treatment: what the latest figures reveal. London: NTA. Policy Innovation Research Unit (2012) Advisory Note to the Department of Health on the Evaluation of the Drug Recovery Wing Pilots Programme. Available at: [last accessed 2nd September 2014] Plugge, E; Douglas, N and Fitzpatrick, R (2006) The Health of Women in Prison Study Findings. Oxford: University of Oxford Prison Reform Trust (2011) Reforming Women s Justice: Final report of the Women s Justice Taskforce. London: PRT Prison Reform Trust (2013) Prison Reform Trust briefing: Why focus on reducing women s imprisonment. London: PRT